Neurophysiological tests and neuroimaging procedures in non-acute headache: guidelines and recommendations

Area of Science:

• Neurology
• Diagnostic Imaging
• Neurophysiology

Background:

• Instrumental examination use in headache patients varies widely.
• An EFNS Task Force evaluated common instrumental procedures for non-acute headache patients based on literature evidence.

Purpose of the Study:

• To provide guidelines for the clinical use of instrumental examinations in headache patients.
• To evaluate the usefulness of common neurophysiological tests and imaging procedures.

Main Methods:

• Literature review and evidence synthesis by an EFNS Task Force.
• Evaluation of electroencephalography (EEG), evoked potentials, autonomic tests, muscle palpation, pressure algometry, electromyography (EMG), neuroimaging (MRI, PET, SPECT), nuclear medicine, and transcranial Doppler.

Main Results:

• Routine interictal EEG, evoked potentials, and autonomic tests are not indicated for headache diagnosis.
• Manual palpation can aid in patient subgrouping, but not diagnosis; pressure algometry and EMG are not recommended.
• Routine neuroimaging is not warranted for typical migraine; MRI may be indicated for atypical patterns or neurological signs. PET, SPECT, nuclear medicine, and Doppler have limited diagnostic value in routine headache evaluation.

Conclusions:

• Many instrumental examinations offer limited value in routine headache diagnosis.
• Specific indications exist for EEG (epilepsy differential), ictal EEG (hemiplegic/basilar migraine), and MRI (atypical headaches).
• Further research using these tools is valuable for understanding headache pathophysiology and treatment effects.